Mitigating Risk of Endemic MRSA and VRE Transmission with the Discontinuation of Contact Precautions: Finding the Solution
Implement Innovative Environmental Hygiene Strategies
Despite the scrutiny that environmental cleanliness has received to prevent transmission of these organisms, cleaning practices utilized during daily and terminal cleaning have been found to be suboptimal. Many studies associate environmental contamination with the transmission of MRSA and VRE.5 Recognizing that microbial contamination occurs continuously, use of a disinfection technology which has an antimicrobial residue that persists for 24 hours, can prevent recontamination with MRSA and VRE on surfaces and portable medical equipment for 24 hours. The continuously active disinfectant, Sani-24® Germicidal Spray , has a 4–5 log10 reduction in 5 minutes over 24 hours for S. aureus and VRE.6 This technology offers an innovative strategy for daily room cleaning as many patients colonized with MRSA, VRE and other epidemiologically important pathogens are not identified upon admission and may contaminate the environment during their stay. Additionally, after a patient on contact precautions for MRSA and VRE infections is discharged, enhanced terminal disinfection with ultraviolet-C has led to reduced environmental bioburden with these multidrug-resistant organisms.7 Patients admitted to rooms previously occupied by patients harboring a multidrug-resistant organism (MRSA, VRE or Acinetobacter baumannii) were 10–30% less likely to acquire the same organism if the room was terminally disinfected using UV-C following manual cleaning.8
Promote Patient Hand Hygiene
Mody et al9 studied the role of patient hand contamination and the correlation with contamination on high-touch room surfaces and found that patient hand contamination with multidrug-resistant organisms is common; in the case of MRSA, molecular typing demonstrated a high correlation between MRSA on the patient hands and room surfaces. The authors concluded that patient hand hygiene protocols should be implemented and evaluated for their ability to reduce environmental contamination, pathogen transmission, and HAIs, as well as to increase meaningful patient engagement in the prevention of infection. This is a call to introduce easily accessible alcohol-based hand wipes, e.g., Sani-Hands® Instant Hand Sanitizing Wipes, to patients in healthcare settings.
S. aureus Body and Nasal Decolonization
S. aureus has been a target for HAI reduction efforts due to its prevalence in healthcare settings, virulence, and multidrug-resistance, and importantly, the propensity for S. aureus nasal carriage – with persistent carriage present in 20-30% of healthy adults10 – to lead to infection when host defenses are breached e.g., surgery, invasive devices. Nasal decolonization, with or without chlorhexidine gluconate bathing, has become an important strategy for reducing SSIs due to S.aureus and for the control of MRSA transmission in healthcare settings with endemic prevalence and is endorsed by CDC and many professional organizations.11 Historically, mupirocin was the gold standard for nasal decolonization; however, poor patient compliance and mupirocin resistance, along with increasing research demonstrating the efficacy of povidone-iodine (PVP-I), resulted in CDC recommending intranasal povidone-iodine as an alternative to mupirocin. Profend® Nasal Decolonization Kit, a 10% PVP-I nasal decolonizing agent, has proven efficacy against S. aureus, is easy to apply, has minimal adverse reactions, and offers a positive experience for patients.
5Carling P. Methods for assessing the adequacy of practice and improving room disinfection. Am J Infect Control. 2013;41:S20-S25.
6Rutala WR, Gergen MF, Sickbert-Bennett EE, et al. Antimicrobial activity of a continuously active disinfectant against healthcare pathogens. Infect Control Healthcare Epidemiol. 2019; 1-3.
7 Rutala WA, Gergen MF, Weber DJ. Room decontamination with UV radiation. Infect Control Hosp Epidemiol 2010; 31: 1025–29.
8 Anderson DJ, Chen LF, Weber DJ, et al. Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection Study): a cluster-randomised, multicentre, crossover study. Lancet. 2017; 389:805–814. [PubMed: 28104287]
9Mody L, Washer LL, Kaye K, et al. Multidrug-resistant organisms in hospitals: What is on patients hands and in their rooms. CID 2019
10Boyce JM. Preventing Staphylococcal Infections by Eradicating Nasal Carriage of Staphylococcus aureus: Proceeding with Caution. Infect Control Hosp Epidemiol 1996;17(12):775-78.
11Centers for Disease Control Morbidity and Mortality Weekly Report. Vital Signs: Epidemiology and Recent Trends in MSSA and MRSA Bloodstream Infections – United States. March 5, 2019, Volume 68.